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Korkes F, Timoteo F, Baccaglini W, Glina F, Faba OR, Palou Redorta J, Glina S. Postoperative Mortality Rate after Radical Cystectomy: A Systematic Review of Epidemiologic Series. Urol Int 2022; 107:96-104. [PMID: 36382647 DOI: 10.1159/000524578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 03/21/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Mortality after radical cystectomy (RC) varies widely in the literature. In cohort studies, mortality rates can vary from as low as 0.5% in large-volume academic centers (2) to as high as 25% in developing countries series. This study aims to perform a systematic review of population-based studies reporting mortality after RC. METHODS A Systematic search was performed in Medline (PubMed®), Embase, and Cochrane for epidemiologic studies reporting mortality after RC. Institutional cohorts and those reporting mortality for specific groups within populations were excluded. Case series and non-epidemiologic series were also excluded. The aim of this review is to evaluate in-hospital mortality (IHM), 30-day mortality (30M), and 90-day mortality (90M). RESULTS Systematic search resulted in 42 papers comprising 449,661 patients who underwent RC from 1984 to 2017. Mean age was 66.1. Overall IHM, 30M, and 90M were 2.6%, 2.7%, and 4.9%, respectively, with 90M being 2.6 times higher than IHM on average. Lowest IHM was found in Canada and Australia (0.2% and 0.6%, respectively), while the highest IHM was 7.8% (Brazil). Canada and Spain showed the highest 90M (6.5%). 159,584 urinary diversions were analyzed, being mostly ileal conduits (76.8%). CONCLUSIONS The majority of the studies available are from major developed economies with paucity of data in the developing world. 90M after RC tends to be at least twice as high as IHM. The knowledge of such epidemiologic data is vital to guide public policies, such as centralization, in order to reduce mortality.
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Affiliation(s)
- Fernando Korkes
- Division of Urology, Faculdade de Medicina Do ABC, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Frederico Timoteo
- Division of Urology, Faculdade de Medicina Do ABC, São Paulo, Brazil, .,Hospital Israelita Albert Einstein, São Paulo, Brazil,
| | - Willy Baccaglini
- Division of Urology, Faculdade de Medicina Do ABC, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Felipe Glina
- Division of Urology, Faculdade de Medicina Do ABC, São Paulo, Brazil
| | | | | | - Sidney Glina
- Division of Urology, Faculdade de Medicina Do ABC, São Paulo, Brazil
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Sharma AP, Singh S, Devana SK, Chaudhary K, Pareek T, Singh SK. Utility of WhatsApp in emergency urological practice: An interrater reliability study. Indian J Urol 2022; 38:29-33. [PMID: 35136292 PMCID: PMC8796770 DOI: 10.4103/iju.iju_107_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/20/2021] [Accepted: 12/06/2021] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The messaging application 'WhatsApp' is used in clinical practice, often for communication between a medical trainee and a consultant. We designed this study to find the interrater reliability of the data transmitted through this application and validating its use in urological practice. MATERIALS AND METHODS Clinical details and computerized tomographic (CT) images of 30 patients visiting the urology emergency were posted in a closed WhatsApp group involving three consultants (SKD, APS, and KC). The CT images were posted in the WhatsApp group as Whole Image (WI) and Image of Interest (IOI) format and rated on a scale of 1-5. The consultants formulated a provisional diagnosis and initial management strategy. The interrater reliability of these responses was analyzed in the study. RESULTS Mean WI rating ranged from 3.03 ± 0.61 to 3.73 ± 0.64 (Cronbach alfa [α]-0.494, P = 0.006). Mean IOI rating ranged from 3.4 ± 0.56 to 4.13 ± 0.73 (α-0.824, P < 0.0001). For diagnosis, the proportion of observed agreement (P0) was 83.3% for SKD and APS, 76.6% for SKD and KC, and 73.3% for APS and KC. For management, P0 was 86.6% for APS and KC, 86.6% for SKD and APS, and 80% for SKD and KC. CONCLUSIONS WhatsApp Messenger serves to transmit good quality pictures of CT scan images. A reasonable diagnosis and management strategy can be formulated using this app with fair inter-rater reliability.
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Affiliation(s)
| | - Saket Singh
- Department of Urology, PGIMER, Chandigarh, India
| | | | | | - Tarun Pareek
- Department of Urology, PGIMER, Chandigarh, India
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Korkes F, Timóteo F, Martins S, Nascimento M, Monteiro C, Santiago JH, Baccaglini W, Silveira MA, Pedroso EF, Gava MM, Patel P, Spiess PE, Glina S. Dramatic Impact of Centralization and a Multidisciplinary Bladder Cancer Program in Reducing Mortality: The CABEM Project. JCO Glob Oncol 2021; 7:1547-1555. [PMID: 34767463 PMCID: PMC8594663 DOI: 10.1200/go.21.00104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Muscle-invasive bladder cancer (MIBC) is an aggressive disease with a complex treatment. In Brazil, as in most developing countries, data are scarce, but mortality seems exceedingly high. We have created a centralization program involving a multidisciplinary clinic in a region comprising seven municipalities. The aim of this study is to evaluate the impact of a multidisciplinary clinic and a centralization-of-care program (CABEM program) on MIBC treatment in Brazil. PATIENTS AND METHODS A total of 116 consecutive patients were evaluated. In group 1, 58 patients treated for MIBC before establishing a bladder cancer program from 2011 to 2017 were retrospectively evaluated. Group 2 represented 58 patients treated for MIBC after the implementation of the CABEM centralization program. Age, sex, staging, comorbidity indexes, mortality rates, type of treatment, and perioperative outcomes were compared. RESULTS Patients from group 2 versus 1 were older (68 v 64.2 years, P = .02) with a higher body mass index (25.5 v 22.6 kg/m2, P = .017) and had more comorbidities according to both age-adjusted Charlson Comorbidity Index (4.2 v 2.8, P = .0007) and Isbarn index (60.6 v 43.9, P = .0027). Radical cystectomy (RC) was the only treatment modality for patients in group 1, whereas in group 2, there were 31 (53%) RC; three (5%) partial cystectomies; seven (12%) trimodal therapies; 13 (22%) palliative chemotherapies; and three (5%) exclusive transurethral resections of the bladder tumor. No patient in group 1 received neoadjuvant chemotherapy, whereas it was offered to 69% of patients treated with RC. Ninety-day mortality rates were 34.5% versus 5% for groups 1 versus 2 (P < .002). One-year mortality was also lower in group 2. CONCLUSION Our data support that a centralization program, a structured bladder clinic associated with protocols, a multidisciplinary team, and inclusion of chemotherapy and radiotherapy treatments can pleasingly improve outcomes for patients with MIBC.
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Affiliation(s)
- Fernando Korkes
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil.,Hospital Municipal da Vila Santa Catarina and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Frederico Timóteo
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil.,Hospital Municipal da Vila Santa Catarina and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Suelen Martins
- Division of Oncology, Faculdade de Medicina do ABC, Santo André, Brazil
| | | | - Camila Monteiro
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
| | - José H Santiago
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
| | - Willy Baccaglini
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil.,Hospital Municipal da Vila Santa Catarina and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcel A Silveira
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
| | - Eduardo F Pedroso
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
| | - Marcello M Gava
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
| | | | | | - Sidney Glina
- Division of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
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Huang S, Chen H, Li T, Pu X, Liu J, Bi X. Comparison of survival in elderly patients treated with uretero-cutaneostomy or ileal conduit after radical cystectomy. BMC Geriatr 2021; 21:49. [PMID: 33441098 PMCID: PMC7807694 DOI: 10.1186/s12877-020-01861-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/31/2020] [Indexed: 11/10/2022] Open
Abstract
Background In bladder cancer patients with age ≥ 80 years old, there have been controversies in performing uretero-cutaneostomy or ileal conduit as urinary diversion after radical cystectomy. Limited study evaluated overall survival (OS) and cancer-specific survival (CSS) between the two urinary diversions in elderly patients. This study is to compare OS and CSS between uretero-cutaneostomy and ileal conduit after radical cystectomy in bladder cancer patients with age ≥ 80 years old. Patients and methods Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Bladder cancer patients diagnosed between 2004 and 2016 with age ≥ 80 years old who underwent radical cystectomy with either UC or IC were selected. After propensity score matching, Cox regression and Kaplan-Meier analysis were used to analyze the survival. We calculated statistical power for survival. Results Of 1394 patients who met the inclusion criteria, 1093 underwent ileal conduit and 301 underwent uretero-cutaneostomy. After propensity score matching, 285 patients were included in each group. Multivariable Cox analysis showed urinary diversion was not a risk factor of OS and CSS (HR 1.044, [95% CI 0.867–1.257] and 1.012 [0.748–1.368], respectively). Both OS and CSS were not significantly different, with median survival of ileal conduit and uretero-cutaneostomy were 19 [16–24] months and 19 [15–26] months respectively. Additionally, We found OS had the following risk factors: tumor stage (distant vs regional vs localized, 5.332 [3.610–7.875] vs 1.730 [1.375–2.176] vs 1), node density (>0.2 vs ≤0.2 vs none, 1.410 [1.047–1.898] vs 0.941 [0.658–1.344] vs 1) and age (1.067 [1.032–1.103] for each year). While CSS had the following risk factors: tumor stage (distant vs regional vs localized, 4.035 [2.046–7.959] vs 2.476 [1.651–3.713] vs 1), node density (>0.2 vs ≤0.2 vs none, 2.501 [1.645–3.804] vs 1.062 [0.590–1.914] vs 1) and tumor size (greater than 3 cm vs less than 3 cm, 1.596 [1.057–2.412] vs 1). Our analysis obtained 0.707 power for overall survival. Conclusion Urinary diversion by uretero-cutaneostomy or by ileal conduit was not associated with overall and cancer-specific survival. It is reasonable to consider uretero-cutaneostomy as a regular procedure of urinary diversion in elderly bladder cancer patients after radical cystectomy to avoid associate complications.
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Affiliation(s)
- Shang Huang
- Department of Urology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Hanzhong Chen
- Department of Urology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Teng Li
- Department of Urology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Xiaoyong Pu
- Department of Urology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Jiumin Liu
- Department of Urology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Xuecheng Bi
- Department of Urology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, Guangdong, China.
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Korkes F, Maluf F. Increasing costs from bladder cancer in the Brazilian Health System: the role of establishing public health policies. Int Braz J Urol 2020; 47:443-447. [PMID: 33284548 PMCID: PMC7857771 DOI: 10.1590/s1677-5538.ibju.2020.0658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/10/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Fernando Korkes
- Disciplina de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil.,Departamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Fernando Maluf
- Hospital da Beneficencia Portuguesa de São Paulo, São Paulo, Brasil
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Korkes F, Cunha FTS, Nascimento MP, Rodrigues AFS, Baccaglini W, Glina S. Mortality after radical cystectomy is strongly related to the institution's volume of surgeries. EINSTEIN-SAO PAULO 2020; 18:eAO5628. [PMID: 33295426 PMCID: PMC7690935 DOI: 10.31744/einstein_journal/2020ao5628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/24/2020] [Indexed: 11/09/2022] Open
Abstract
Objective: To analyze mortality rates and hospitalization data after radical cystectomy in each public healthcare center in São Paulo in the last decade, considering the number of surgeries performed at each center. Methods: This study included patients from the Departamento de Informática do Sistema Único de Saúde from the state of São Paulo, who underwent radical cystectomy between 2008 and 2018. Data analyzed included organization name, number of procedures/year, in-hospital death rates and hospital length of stay. Results: A total of 1,377 radical cystectomies were registered in the public health system in São Paulo, between 2008-2018. A total of 91 institutions performed at least one radical cystectomy in the decade analyzed. The number of radical cystectomies performed per organization during the years analyzed ranged from one to 161. Only 45.6% of patients were operated in organizations that performed more than five radical cystectomies yearly. A total of 684 patients were operated in organizations with higher surgical volume. There were 117 in-hospital deaths, representing an 8.5% mortality rate for the state of São Paulo during the last decade. Whereas highest volume organizations (>6 radical cystectomies/year) had a mortality rate of 6.1%, the lowest volume (<1 radical cystectomy /year) had a 17.5% in-hospital mortality rate. Conclusion: There was a strong relation between organization volume of radical cystectomy and in-hospital mortality rate after radical cystectomy in São Paulo from 2008-2018. Unfortunately, we could not observe a trend toward centralization of such complex procedures, as it has occurred in developed countries during the last decades.
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Affiliation(s)
| | | | | | | | | | - Sidney Glina
- Faculdade de Medicina do ABC, Santo André, SP, Brazil
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